冠状动脉CT血管造影获得的无创血流储备分数对心肌缺血的诊断价值  

Retrospective study on the diagnostic performance of noninvasive fractional flow reserve derived from coronary CT angiography for myocardial ischemia

作　　者：单冬凯[1] 杨俊杰[1] 窦冠华 荆晶[1] 杜洛山[1] 何柏[1] 陈韵岱[1] SHAN Dong-kai;YANG Jun-jie;DOU Guan-hua;JING Jing;DU Luo-shan;HE Bai;CHEN Yun-dai(Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院心血管内科,北京100853

出　　处：《解放军医学杂志》2018年第1期33-37,共5页Medical Journal of Chinese People's Liberation Army

基　　金：国家重点研发计划项目(2016YFC1300300)~~

摘　　要：目的评价应用国产化冠状动脉CT血管造影(CTA)图像模拟的无创血流储备分数(FFRCT)对功能性心肌缺血的诊断价值。方法回顾性纳入2012年8月-2015年7月解放军总医院同期行冠脉CTA和FFRCT检查的39例患者,基于冠脉CTA图像通过流体力学原理模拟计算FFRCT值,以有创的FFR值为参考标准,分别从患者水平和血管水平计算FFRCT对功能性心肌缺血的诊断准确性、特异度、敏感度、阳性预测值和阴性预测值。结果在患者水平FFRCT的诊断准确性为82.05%,敏感度为83.33%,特异度为80.95%,阳性预测值为78.95%,阴性预测值为85.00%;在血管水平FFRCT的诊断准确性为76.79%,敏感度为69.57%,特异度为81.82%,阳性预测值为72.73%,阴性预测值为79.41%。在患者水平FFRCT的ROC曲线下面积为0.826;在血管水平FFRCT的ROC曲线下面积为0.786。在血管水平,FFRCT值与FFR值之间呈显著正相关(r=0.644,95%CI:0.458~0.775)。结论以FFR值作为参考标准,应用国产化无创FFRCT技术诊断功能性心肌缺血具有较高的准确率,临床应用前景较好。Objective To evaluate the diagnostic performance of noninvasive fractional flow reserve（FFR） derived from coronary computed tomographic angiography（CTA）（FFRCT） for functional myocardial ischemia. Methods Thirty-nine patients undergone coronary CTA and FFR examination from Aug. 2012 to Jul. 2015 in PLA General Hospital were retrospectively included in present study. Measurements of invasive FFR value was used as reference standard, and FFRCT based on coronary CTA image was performed in either per-patient or per-vessel level to assess the accuracy, specificity, sensitivity, the positive predictive value and negative predictive value for functional myocardial ischemia. Results In per-patient level, the accuracy of FFRCT was 82.05%, sensitivity was 83.33%, specificity was 80.95%, positive predictive value was 78.95% and negative predictive value was 85.00%. In per-vessel level, the accuracy of FFRCT was 76.79%, sensitivity was 69.57%, specificity was 81.82%, positive predictive value was 72.73% and negative predictive value was 79.41%. The area under ROC was 0.826 in per-patient level, and 0.786 in per-vessel level. For per-vessel, FFRCT was positively correlated with FFR value significantly（r=0.644; 95%CI： 0.458-0.775）. Conclusion With FFR as reference standard, domestic noninvasive FFRCT can be used for the diagnosis of functional myocardial ischemia with high diagnostic performance and clinical application prospect.

关 键 词：冠状动脉粥样硬化性心脏病 冠脉血流储备分数 冠状动脉 计算机体层摄影血管造影 

分 类 号：R541.4[医药卫生—心血管疾病]